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Portosystemic shunt

Yan Song, Weizhi Li, Hui Xue, Litao Ruan
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is the method of choice for the treatment of portal hypertension. The Tei index is the most sensitive indicator of myocardial function. DESIGN: This study enrolled 31 patients with cirrhosis who underwent TIPS and were followed up over a median period of 34 months (range 2-60 months). Baseline Meld score and the changes in the Tei index within 1 month after TIPS and their potential relationship with prognosis were evaluated...
December 1, 2018: Echocardiography
Jiaywei Tsauo, He Zhao, Xiaowu Zhang, Huaiyuan Ma, Mingshan Jiang, Ningna Weng, Xiao Li
OBJECTIVES: To evaluate the changes in arterial oxygenation after portal decompression in Budd-Chiari syndrome (BCS) patients with hepatopulmonary syndrome (HPS). METHODS: From June 2014 to June 2015, all patients with BCS who underwent balloon angioplasty or transjugular intrahepatic portosystemic shunt (TIPS) creation at our institution were eligible for inclusion in this study. Arterial blood gas analysis was performed with the patient in an upright position and breathing room air at 2-3 days and 1 and 3 months after the procedure...
November 30, 2018: European Radiology
Rohini Krishna, Samuel O Igbinedion, Richie Diaz, Nazneen Hussain, Moheb Boktor
With alcoholic cirrhosis and nonalcoholic fatty liver disease continuously on the rise in the United States, there is also a corresponding rise in portal hypertension. Portal hypertensive duodenopathy (PHD) is a complication of portal hypertension not commonly seen in cirrhotic patients. We present a case of a 46-year-old man who presented with decompensated liver cirrhosis secondary to gastrointestinal bleed. The patient underwent esophagogastroduodenoscopy (EGD) with findings indicative of PHD. Patient subsequently underwent transjugular intrahepatic portosystemic shunt (TIPS) with resolution of gastrointestinal bleed...
2018: Case Reports in Gastrointestinal Medicine
Malay Sharma, Piyush Somani, Chittapuram Srinivasan Rameshbabu, Tagore Sunkara, Praveer Rai
The liver has eight segments, which are referred to by numbers or by names. The numbering of the segments is done in a counterclockwise manner with the liver being viewed from the inferior surface, starting from Segment I (the caudate lobe). Standard anatomical description of the liver segments is available by computed tomographic scan and ultrasonography. Endoscopic ultrasound (EUS) has been used for a detailed imaging of many intra-abdominal organs and for the assessment of intra-abdominal vasculature. A stepwise evaluation of the liver segments by EUS has not been described...
November 16, 2018: World Journal of Gastrointestinal Endoscopy
Kapil Rajwani, Brett E Fortune, Robert S Brown
Gastrointestinal (GI) bleeding and ascites are two significant clinical events that frequently present in critically ill patients with chronic liver failure or decompensated cirrhosis. GI bleeding in patients with cirrhosis, particularly portal hypertensive-associated bleeding, carries a high short-term mortality (15-25%) and requires early initiation of a vasoactive agent and antibiotics as well as timely endoscopic management. Conservative transfusion strategies and adequate airway protection are also imperative to assist in bleeding control...
October 2018: Seminars in Respiratory and Critical Care Medicine
Manabu Nakazawa, Yukinori Imai, Hiroshi Uchiya, Satsuki Ando, Kayoko Sugawara, Nobuaki Nakayama, Tomoaki Tomiya, Satoshi Mochida
Aim: Portosystemic shunts aggravate liver function by decreasing portal blood flow. The usefulness of balloon-occluded retrograde transvenous obliteration (B-RTO), a standardized therapeutic procedure for gastric fundal varices (GFV), for the improvement of liver function was evaluated in cirrhotic patients with or without varices. Methods: The subjects were 161 patients with portosystemic shunts. A balloon catheter was inserted into the shunts, followed by the injection of 5% ethanolamine oleate through the catheter under balloon inflation...
December 2017: JGH open: an open access journal of gastroenterology and hepatology
Madeleine L Roberts, Stacy Rine, Amy Lam
Case summary: A 4-month-old neutered male Russian Blue kitten had a 4 week history of hypersalivation and failure to thrive. In addition, there was a 2 week history of soft tissue swelling on the ventral abdomen, which had failed to improve with antimicrobial therapy. There were no significant physical examination or neurological deficits on examination; however, the cat had a quiet demeanour for its age. Postprandial bile acids were increased (32 µmol/l; reference interval <25 µmol/l)...
July 2018: JFMS Open Reports
Cortlandt M Sellers, Nariman Nezami, Michael L Schilsky, Hyun S Kim
Liver transplantation is one of the mainstays of treatment for liver failure due to severe chronic liver disease. Bridging therapies, such as placement of a transjugular intrahepatic portosystemic shunt (TIPS), are frequently employed to control complications of portal hypertension such as ascites, hydrothorax, and variceal bleeding, and thereby reduce morbidity in patients awaiting transplant. There is no significant difference seen in either graft survival or patient survival between those receiving TIPS pre-transplant and those who do not, although those receiving TIPS placement on average have a longer waiting time on the transplant waitlist...
October 31, 2018: Transplantation Reviews
Mariana I Chavez, Susan Tsai, Callisia N Clarke, Mohammed Aldakkak, Michael O Griffin, Abdul H Khan, Paul S Ritch, Beth A Erickson, Douglas B Evans, Kathleen K Christians
BACKGROUND: When pancreatic neoplasms occlude or encase the superior mesenteric-portal-splenic vein confluence with abutment of the posterior lateral wall of the superior mesenteric artery, a mesocaval shunt with or without a distal splenorenal shunt allows for safe dissection of the porta hepatis and separation of the pancreatic tumor from the superior mesenteric artery. Herein we report long-term results of the largest known series of portosystemic shunts performed at the time of pancreatectomy...
November 21, 2018: Surgery
M Sobczak-Filipiak, T Męcik-Kronenberg, M Czopowicz, M Galanty, P Trębacz, J Frymus, I Badurek, J Szarek
Lipogranulomas are lesions found in histopathological liver examination in humans and in various animal species, including dogs, especially those with portosystemic shunts. They consist of macrophages and other inflammatory cells, and sometimes they contain iron salts (pigment granuloma). This study aimed at determining the number of granulomas and cellular composition of lipogranulomas in dogs with the congenital extrahepatic portosystemic shunt, and to identify factors associated with their development. 44 archival liver samples from dogs with portosystemic shunt were stained using HE, Perl's method and - in randomly-selected cases - immunohistochemically against CD56, CD20 and CD3 (DAKO)...
June 2018: Polish Journal of Veterinary Sciences
Susana G Rodrigues, Sebastian Sixt, Juan G Abraldes, Andrea De Gottardi, Christoph Klinger, Jaime Bosch, Iris Baumgartner, Annalisa Berzigotti
BACKGROUND: Transjugular intrahepatic portosystemic shunt has been increasingly used in patients with portal vein thrombosis to obtain patency, but evidenced-based decisions are challenging. AIM: To evaluate published data on efficacy and safety of endovascular therapy in portal vein thrombosis. METHODS: Systematic search of PubMed, ISI, Scopus, and Embase for studies (in English, until October 2017) reporting feasibility, safety, 12-month portal vein recanalisation, transjugular intrahepatic portosystemic shunt patency, and survival in patients with benign portal vein thrombosis undergoing endovascular treatment...
November 18, 2018: Alimentary Pharmacology & Therapeutics
Michelle Robyn Joffe, Evelyn Hall, Christopher Tan, Laurencie Brunel
OBJECTIVE: To compare mechanisms of and pressures at failure of 4 methods of securing 2 types of cellophane bands around a vein. STUDY DESIGN: Ex vivo mechanical evaluation. METHODS: Cellophane bands composed of 3 or 4 layers were applied around a cadaveric external jugular vein (EJV) to create 25% or 50% attenuation. These bands were secured with a medium or medium-large polymer locking ligation clip (PLLC), or a medium or medium-large titanium ligation clip (TLC)...
November 17, 2018: Veterinary Surgery: VS
Edwin A Takahashi, James C Andrews
A 72-year-old male presented with refractory ascites secondary to portal vein occlusion with cavernomatous transformation following pancreaticoduodenectomy (Whipple procedure). Due to the unfavorable anatomy, transjugular intrahepatic portosystemic shunt was not an option. However, given patency of the spleno-mesenteric confluence and absence of the pancreatic head after the Whipple procedure, a splenomeso-caval shunt was successfully created using a transjugular-transsplenic rendezvous technique.
October 23, 2018: Clinical Imaging
Faisal Khan, Homoyon Mehrzad, Dhiraj Tripathi
Budd-Chiari syndrome (BCS) is a rare but fatal disease caused by the obstruction in hepatic venous outflow tract (usually by thrombosis) and is further classified into two subtypes depending on the level of obstruction. Patients with BCS often have a combination of prothrombotic risk factors. Clinical presentation is diverse. Stepwise management strategy has been suggested with excellent 5-year survival rate. It includes anticoagulation, treatment of identified prothrombotic risk factor, percutaneous recanalization, and transjugular intrahepatic portosystemic shunt (TIPS) to reestablish hepatic venous outflow and liver transplantation in unresponsive patients...
September 2018: Journal of Translational Internal Medicine
John Ong, Michael F Bath, Carla Swift, Yasseen Al-Naeeb
Aim: The aim of this systematic review was to determine if the human colon, through the lower gut-liver axis, drives PSC activity by assessing the progression of the disease in patients with and without colectomy for colonic disease. Background: The gut-liver axis is involved in the pathogenesis of liver disease. Abnormal immune-mediated responses to intestinal microbiome are implicated in primary sclerosing cholangitis (PSC) however the mechanisms remain poorly understood...
2018: Gastroenterology and Hepatology From Bed to Bench
Driss Raissi, Elizabeth A Roney, Mohamed M Issa, Sreeja Sanampudi, Michael A Winkler
Transjugular intrahepatic portosystemic shunt (TIPS) periprocedural thrombosis rates have fallen significantly since the introduction of polytetrafluoroethylene-covered stent grafts. We present a case of a cirrhotic patient with portal hypertension presenting with early TIPS thrombosis in association with an underlying competing spontaneous left mesenterico-gonadal venous shunt, an uncommon variant of spontaneous portal systemic shunt (SPSS). The patient presented with bleeding distal duodenal varices refractory to endovascular therapy, and although a successful TIPS procedure was performed for this indication, early thrombosis was determined by follow-up abdominopelvic computed tomographic angiography (CTA) scan...
October 27, 2018: Clinical Imaging
Alexander Weigert, Jeanette Bierwolf, Heiko Reutter, Ulrich Gembruch, Joachim Woelfle, Rainer Ganschow, Andreas Mueller
BACKGROUND: Congenital portosystemic shunts present with various associated complications, such as other congenital malformations, hyperammonemia, or hepatopulmonary syndrome. Few cases of associated hypoglycemia have been reported so far and our case, to the best of our knowledge, describes the most severe extent of hypoglycemia. CASE PRESENTATION: We describe the case of a newborn Arab boy with two intrahepatic portosystemic shunts, resulting in severe and persistent hypoglycemia, due to which one of the shunts was closed by interventional radiology whereas the other shunt had already closed spontaneously...
November 12, 2018: Journal of Medical Case Reports
Yonghua Bi, Hongmei Chen, Pengxu Ding, Pengli Zhou, Xinwei Han, Jianzhuang Ren
This study aimed to evaluate the long-term efficacy and safety of percutaneous transhepatic balloon angioplasty (PTBA) and transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the treatment of Budd-Chiari syndrome (BCS) with hepatic veins involvement. Between June 2008 and August 2016, a total of 60 BCS patients with hepatic vein involvement in our department were enrolled in this study. Thirty-three cases underwent hepatic vein balloon angioplasty in PTBA Group and 27 cases underwent TIPSS. Data were retrospectively collected, and follow-up observations were performed...
October 2018: Medicine (Baltimore)
Joseph W Owen, Nael E Saad, Glenn Foster, Kathryn J Fowler
PURPOSE: To demonstrate the feasibility of detecting patency, stenosis, or occlusion of transjugular intrahepatic portosystemic shunt (TIPS) with four-dimensional (4D) flow MR imaging. MATERIALS AND METHODS: Sequential adult patients with TIPS were eligible for enrollment. Volumetric phase-contrast sequence was used to image TIPS. Particle tracing cine images were used for qualitative assessment of stenosis. TIPS was segmented to generate quantitative data sets of peak velocity...
November 2, 2018: Journal of Vascular and Interventional Radiology: JVIR
Yuichi Takama, Takehisa Ueno, Satoshi Umeda, Ryuta Saka, Yuko Tazuke, Hiroomi Okuyama
PURPOSE: A congenital extrahepatic portosystemic shunt (CEPS) associated with hyperammonemia requires occlusion of the shunt vessels. We evaluated the effectiveness and safety of laparoscopic ligation of a CEPS in children with hyperammonemia. METHODS: The subjects of this retrospective study were seven children with hyperammonemia who underwent laparoscopic ligation of a CEPS. Their median age was 5.2 years (range 1-16 years). Before the laparoscopic procedure, a catheter was inserted through the femoral vein and placed in the portal vein via the shunt vessel...
November 3, 2018: Surgery Today
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